The purpose of this blog is to gather information about how to support caregivers of children. The quality of the caregiving relationship in infants and young children, central to the healthy development of the growing child, can be enhanced by attention to the caregivers in the form of education and other support. This blog will become an archive for information on these issues.

Tag Archives: self-reflection

September is a turbulent time of year for young children. Recently, a mother of a preschool boy contacted me to ask me what to do. She asked me about a problem with her son’s sleep and also with an exacerbation of temper tantrums. I will call him Andrew. Three-year old Andrew has always had trouble with sleep, but just before the start of school he began waking up at night and insisting on sleeping in his parents’ room. The temper outbursts seemed random and were shocking to the adults present. For example, recently when his beloved grandmother came for a visit, he ran up to her and punched her. Then he refused to apologize. Andrew’s worried parents were exhausted by his frequent waking during the night and felt helpless to deal with his temper outbursts. Time outs had never really worked for Andrew. His mother asked me for suggestions.

Before giving her mother any suggestions, I visited Andrew at school. This was Andrew’s second year at school, and he was in a different classroom with a larger number of children and more activities. In the classroom, Andrew’s behavior showed that he was excited and proud to be such a big boy. There was a little swagger in his walk as he rushed over to meet his returning classmates with a friendly and confident greeting. However, Andrew’s confident behavior was an over reach. On several occasions his old friends, who were having their own difficulties accommodating to the beginning of school, were unable to reciprocate his exuberant greeting and clung to their parents or held back in preoccupied silence. When this happened, Andrew’s confidence instantly melted. His face fell, his shoulders sagged, and he slouched away from the other child. It was easy to imagine his inner picture of being Big Man on Campus and how catastrophically it collapsed when the reality of his friends being only 3-yo (as of course so was he) interfered with their ability to play their role in his grandiose fantasy.

Andrew had a similar reaction to a mild correction by a teacher. He had readily and apparently magnanimously given up a toy car to another child who requested a turn, but as it turned out, he hadn’t really had a chance to think it through. He had been playing a wonderful game of collecting pebbles and sticks from the playground for one of his new teachers. His enthusiasm had recruited another classmate in the activity, and they had been happily wheeling around the playground. After a while, his attention strayed and he left the car, which was then claimed by the second child. At this point, Andrew looked around at the other child whizzing off in the car, and his disappointment was obvious. “Now what can I do?” he muttered under his breath. After grumpily refusing multiple alternatives from another teacher, he settled on a smaller vehicle and began pushing it across the playground surface. His friend from the previous activity joined him in this fast-paced game, and his good mood seemed recovered. Then, suddenly a third teacher announced – in a perfectly friendly manner – that children must sit on the seat; pushing the vehicle was not allowed. Again, Andrew’s face and body were transformed into a thundercloud. This time he fell to the ground and hid his face in his hands.

You can see how exhausting a morning it was for Andrew, and it was only 9:30! Insight into the mind of a child like Andrew can guide his parents in their decisions about to handle his sleep problems and his tantrums. After considering what is in Andrew’s mind, his parents might tell him, “You are working so hard to be a big boy, and we are so proud of you. But sometimes you get tired out and can’t act like a big boy any more.” They might then comfort him and assure him that they believed he could “be a big boy again tomorrow”.

They decided to let him sleep in their room for a couple of weeks while he managed the transition to school, with a planned, graded, return to his own bed facilitated by rewards. This approach had the advantage of offering him the support he currently needed with an additional built-in transition-practicing exercise. (By this I mean that the planned return to his bed was another chance to practice making transitions.) In addition, a procedure like this reinforces the link between his inner experience (distress about transitions) and his behavior.

With regard to the assault on his grandmother, they concluded that an apology was too much to expect at the moment. If another such incident occurred, they agreed that they would take his hand and apologize to his grandmother for him (after giving him a chance first) and explain to the grandmother that he was having a hard time recently with starting school, and sometimes his body just bursts out with a mad behavior like the punching (another chance to link the inner experience with the behavior, modeling for him self reflection) and you know he is very sorry about it even if he can’t say it right now. Then, later, they would give him the chance to do something nice for her in reparation.

In this posting, I will discuss the most substantial long-term solution to bullying. The best way to combat bullying is to support the capacity for friendship and children’s development of empathy. Empathy is a function of “theory of mind”, that is, the ability of the child to imagine the thoughts and feelings of another person and to realize that other people have minds of their own.

For example, the 5-yo boy (let’s call him “Sam”) described above was having trouble imagining the mind of his classmate (“Ben”). I discovered that earlier that day in playground time Sam had been involved in a running game with Ben and some other boys. Ben, who is a fast runner, was leading the pack. Sam has some motor insecurity that has held him back, and he has not developed the strength and skill to keep up with the other boys in running games. I am guessing that he was feeling like a “loser”, and his way of making sense of those “loser” feelings was to perceive Ben as being the cause of his “loser-ness” by claiming to be older than Sam was. Ben actually hadn’t said anything of the sort, but Sam’s feelings were so strong and unmanageable that he completely lost his 5-yo capacity for self-reflection (“mentalization”). He did not link his very sad and angry feelings to having been left in the dust in the running game of minutes before. He really perceived Ben as trying to best him by claiming to be older and thereby causing him to feel bad.

Empathy is a complex competency that begins in the early infant-caregiver relationship when the baby first comes to recognize and resonate with the emotions of the caregiver. Parents and teachers can continue to support the development of empathy by valuing empathic responses, by making “being a good friend” a family (and school) value. If this “family value” is established, parents and teachers can always fall back on it as a support when they are confronting bullying behavior. “In this school, we do not believe in treating others that way.” The reason this kind of explanation is such a showstopper is that you can’t argue with beliefs. Empathy can even be extended to the bully.

I would not call Sam a bully – nor do I think the term is appropriate for such a young child – but his behavior was definitely intimidating to Ben. If called into this situation with Sam puffing out his chest threateningly to Ben and calling him a baby and Ben quaking in his boots, his parent or his teacher might try to scaffold the recovery of Sam’s self-reflection, and therefore his empathy. They might try to help him imagine how Ben felt, and they might even elicit Ben’s help in doing that (“Tell Sam how you felt when he said that to you and stood so close to you”).

However, there is a potential pitfall. If Sam is too stressed, the adult’s words – kind and helpful though they might be – will not sink in. Sam cannot take in information when he is dysregulated. The kind words – if they are addressing the source of his distress – might even escalate his dysregulation, The adult must first help Sam (and Ben) calm down, feel safe, and then – maybe twenty minutes later – try again. There are many good children’s books that have friendship as a theme. Some classics are George and Martha, Mrs. Piggle Wiggle, and Freddy the Pig.

About

Alexandra Murray Harrison, M.D. is a Training and Supervising Analyst at the Boston Psychoanalytic Society and Institute in Adult and Child and Adolescent Psychoanalysis, an Assistant Clinical Professor of Psychiatry, Harvard Medical School at the Cambridge Health Alliance, and on the Faculty of the Infant-Parent Mental Health Post Graduate Certificate Program at University of Massachusetts Boston. Dr. Harrison has a private practice in both adult and child psychoanalysis and psychiatry. In the context of visits to orphanages in Central America and India, Dr. Harrison has developed a model for mental health professionals in developed countries to volunteer their consultation services to caregivers of children in care in developing countries in the context of a long term relationship with episodic visits and regular skype and video contact.